Last modified on 16 August 2010, at 16:27
DETAIL TEST SPCH Left breast cancer. Adult-onset diabetic. DETAIL TEST SPCPT Container A-D:88305/FR Container E:88307/FR Tumor in blocks E18, E20. DETAIL TEST SPGD A. "Sentinel node #1", received fresh and placed in formalin. A 2 x 1.4 x 1.2 cm lymph node candidate with attached adipose tissue is sectioned and submitted in toto in block A1. A cytokeratin stain is prospectively requested. B. "Sentinel node #2", received fresh and placed in formalin. A 2.4 x 2 x 1.2 cm aggregate of adipose tissue is dissected for lymph node candidates. Approximately three lymph node candidates are identified and submitted in B1. Cytokeratin stain is prospectively requested. C. "Sentinel node #3", received fresh and placed in formalin. A 3 x 1.5 x 1 cm lymph node candidate with attached adipose tissue is sectioned and submitted in C1-2. A cytokeratin stain is prospectively requested on both blocks. D. "Sentinel node #4". A 2 x 1.2 x 0.8 cm aggregate of adipose tissue is dissected for lymph node candidates. One lymph node candidate 1.5 cm in greatest dimension is sectioned and submitted in toto in D1. A cytokeratin stain is prospectively requested. Container will be dictated subsequentially. E. "Left breast cancer", received fresh and placed in formalin. A 9.7 (M-L) x 7.7 (S-I) x 2.6 (A-P) cm lumpectomy specimen with a 5.0 x 0.4 cm attached skin ellipse. The specimen is inked as follows: superior, inferior-yellow, anterior-blue, posterior-black. The specimen is serially sectioned from medial to lateral to reveal a cut surface that is notable for a dense, fibrous mass that is discolored blue consistent with previous sentinel node mapping. There are punctate areas of hemorrhage in this area consistent with previous biopsy site and needle localization. This firm area is consistent with the radiograph of the specimen indicating the presence of clip and calcifications. The firm area is 2.7 x 2.1 x 2.1 cm in approximate dimension. The remainder of the specimen is mature, yellow, lobulated adipose tissue and is grossly unremarkable. The attached ellipse of skin is also grossly unremarkable. Representative sections are submitted from medial to lateral in blocks E1-40. Please note that block E16 contains the clip and blocks 20-25 contains sections with calcification identified radiographically. J. Jones/slides to Dr. Smith DETAIL TEST SPMI Microscopic examination is performed. DETAIL TEST SPDX A. "SENTINEL NODE NUMBER ONE": ONE LYMPH NODE, POSITIVE FOR METASTATIC CARCINOMA. IMMUNOSTAINS FOR CYTOKERATIN ARE POSITIVE FOR CARCINOMA. B. "SENTINEL LYMPH NODE NUMBER TWO": TWO LYMPH NODES, NEGATIVE FOR MALIGNANCY. IMMUNOSTAINS FOR CYTOKERATIN ARE NEGATIVE FOR CARCINOMA. C. "SENTINEL LYMPH NODE NUMBER THREE": ONE LYMPH NODE, POSITIVE FOR METASTATIC CARCINOMA. IMMUNOSTAINS FOR CYTOKERATIN ARE POSITIVE FOR CARCINOMA. D. "SENTINEL LYMPH NODE NUMBER FOUR": ONE LYMPH NODE, NEGATIVE FOR MALIGNANCY. IMMUNOSTAINS FOR CYTOKERATINS ARE NEGATIVE FOR MALIGNANCY. COMMENT: In total two of five lymph nodes are positive for metastatic carcinoma. Maximum size of an area of metastases within a lymph node is 2 mm, and the metastases are confined to the lymph node, not spreading into the adjacent soft tissue. The lymph node stage is pN1a. The stage of the primary tumor is pT2. E. "LEFT BREAST CANCER" (EXCISION): INVASIVE ADENOCARCINOMA OF THE BREAST. HISTOLOGIC TYPE: DUCTAL. NOTTINGHAM COMBINED HISTOLOGIC GRADE: 3 OF 3. TUBULE FORMATION SCORE: 3 NUCLEAR PLEOMORPHISM SCORE: 3 MITOTIC RATE SCORE: 3 GROSS TUMOR SIZE: 2.7 X 2.1 X 2.1 CM. LYMPHATIC/VASCULAR INVASION: PRESENT. MULTIFOCAL TUMOR: ABSENT. IN-SITU CARCINOMA: PRESENT. TYPE OF IN-SITU CARCINOMA: DUCTAL CARCINOMA IN-SITU, PAPILLARY, CRIBRIFORM, AND SOLID. NUCLEAR GRADE OF IN-SITU CARCINOMA: 3 OF 3. NECROSIS: PRESENT. DCIS EXTENDING OUTSIDE INVASIVE TUMOR MASS: PRESENT. SIZE OF IN-SITU CARCINOMA: SEE COMMENT, AT LEAST 3 CM. STATUS OF NON-NEOPLASTIC BREAST TISSUE: FIBROCYSTIC DISEASE, WITH CHANGES CONSISTENT WITH PRIOR BIOPSY. SIZE OF BIOPSY: 9.7 X 7.7 X 2.6 CM. MICROCALCIFICATIONS: FOCALLY PRESENT. SURGICAL MARGIN STATUS: CLOSE (DUCTAL CARCINOMA IN-SITU IS PRESENT WITHIN 1 MM OF THE BLUE INKED (MEDIAL ANTERIOR) MARGIN IN BLOCKS 8, 12, 13 AND 17 AND PRESENT WITHIN 1 MM OF THE LATERAL ANTERIOR MARGIN IN BLOCK 31. IN-SITU CARCINOMA IS PRESENT WITHIN 1 MM OF THE YELLOW INKED (MEDIAL INFERIOR) MARGIN IN BLOCK 15. IN SITU CARCINOMA IS NOT DEMONSTRATED DIRECTLY IN ANY MARGIN). ESTROGEN/PROGESTERONE RECEPTOR, CELL CYCLE, EGFR AND HER2/NEU ANALYSIS: PERFORMED ON PRIOR BIOPSY. COMMENT: Areas of ductal carcinoma in-situ extend outward beyond invasive carcinoma in multiple blocks. Since this in situ carcinoma did not form a grossly appreciable mass, the exact dimensions are difficult to determine, but the in-situ carcinoma is at least 3 cm across, and probably somewhat larger than this.